Sahak Echo

𝐀𝐨𝐫𝐭𝐢𝐜 𝐑𝐨𝐨𝐭 𝐈𝐧𝐝𝐞𝐱
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Calculated by dividing the observed aortic root dimension (Aorta O) by the BSA.

The aortic root ratio (ARR) of observed (Aorta O)
to expected (Aorta E) aortic root diameters
can be calculated by dividing the observed by
the expected diameter.

⛱ ARI = AortaO / BSA

🏖 O-E ARR = Aorta O / Aorta E

🏜 Z Score = {Aorta O−Aorta E} / SD

𝙎𝙞𝙩𝙚𝙨 𝙛𝙤𝙧 𝙢𝙚𝙖𝙨𝙪𝙧𝙚𝙢𝙚𝙣𝙩𝙨 𝙤𝙛
𝙩𝙝𝙚 𝙖𝙤𝙧𝙩𝙞𝙘 𝙧𝙤𝙤𝙩 𝙖𝙣𝙙 𝙖𝙨𝙘𝙚𝙣𝙙𝙞𝙣𝙜 𝙖𝙤𝙧𝙩𝙖

1. 𝘼𝙤𝙧𝙩𝙞𝙘 𝙫𝙖𝙡𝙫𝙚 𝙖𝙣𝙣𝙪𝙡𝙪𝙨
2. 𝙎𝙞𝙣𝙪𝙨𝙚𝙨 𝙤𝙛 𝙑𝙖𝙡𝙨𝙖𝙡𝙫𝙖
3. 𝙎𝙞𝙣𝙤𝙩𝙪𝙗𝙪𝙡𝙖𝙧 𝙟𝙪𝙣𝙘𝙩𝙞𝙤𝙣
4. 𝙋𝙧𝙤𝙭𝙞𝙢𝙖𝙡 𝙖𝙨𝙘𝙚𝙣𝙙𝙞𝙣𝙜 𝙖𝙤𝙧𝙩𝙖 .

Definitions
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Height Height (cm or in)
Weight Weight (kg or lb)
Aorta O Aorta Observed (mm)
Location Location
BSA Body Surface Area (m2)
ARI (BSA) Aortic Root Indexed to BSA(mm/m2)
Aorta E Aorta Expected (mm)
O-E ARR. O-to-E Aortic Root Ratio
Z Score Z Score
Copy from CCU-ECHO

EMERGENCY PERICARDIOCENTESIS

SUB XIPHOIDAL APPROACH
The extrapleural subcostal pericardiocentesis approach is performed as follows
Introduce the needle substernally 1 cm inferior to the left xiphocostal angle. Once beneath the cartilage cage, lower the needle so it approximates a 30-degree inclination with the chest wall...
Aim the needle toward the left mid-clavicle and advance it slowly while continuously aspirating. If no fluid is aspirated, the needle should be withdrawn promptly and redirected. In the absence of ultrasound guidance, withdraw the needle to the skin and redirect it along a deeper slightly posterior trajectory. The required depth of insertion is affected by the patient's anatomy. In most cases, a 7 to 9 cm needle is adequate, but longer needles (up to 12 cm) may be needed for patients with more anterior thoraco-abdominal soft tissue (eg, class 2 or 3 obesity). In infants and small children, 4 cm (1.5 inch) needles are sufficient.
If no fluid is aspirated on the second attempt, withdraw the needle to the skin and redirect it 10 degrees to the patient's right of the last dry needle aspiration path. Perform systematic redirected aspirations by working from the patient's left to right until the needle is aimed toward the right neck...

Parasternal
The left sternal border is the landmark for a parasternal approach Left parasternal access is most frequently used.
Insert the needle perpendicular to the skin and over the cephalad border of the fifth or sixth rib immediately adjacent to the sternal margin. The cardiac notch of the left lung exposes the pericardium at this site.
Avoid puncturing more laterally (greater than 1 cm) to prevent injury to the internal thoracic (mammary) vessels.

Apical
The apical pericardiocentesis approach reduces the risk of cardiac complications by taking advantage of the proximity to the thick walled left ventricle and the small apical coronary vessels
However, proximity to the left pleural space increases the risk for pneumothorax
The apical insertion site is at least 5 cm lateral to the parasternal approach within the fifth, sixth, or seventh intercostal space. Advance the needle over the cephalad border of the rib and towards the patient's right shoulder.
Copy from cardiovascular educations